Body Image and Eating Disorders Parent Forum April 17, 2013

1. Body Image and Eating Disorders Parent Forum April 17, 2013

2. Messages in the media From the About-Face organization: "400-600 advertisements bombard us everyday in magazines, on billboards, on TV, and in newspapers. One in eleven has a direct message about beauty, not even counting the indirect messages."

3. Men and Media • Muscle and fitness magazines • Action figures have become increasingly muscular and devoid of body fat • Adonis Complex • obsessed with bulk and muscle mass • over exercise • dietary restriction • abuse of anabolic steroids

4. FIJI • Fiji in 1995 - Ethnic Fijians have traditionally encouraged healthy appetites and have preferred a more rotund body type, which signified wealth and the ability to care for one’s family • One case of anorexia nervosa reported on the island prior to 1995. • In 1998, rates of dieting skyrocketed from 0 to 69%, and young people routinely cited the appearance of the attractive actors on shows like “Beverly Hills 90210” and “Melrose Place” as the inspiration for their weight loss. • For the first time, inhabitants of the island began to exhibit disordered eating.

5. Eating Disorders Anorexia Nervosa Bulimia Nervosa Eating disorders have the highest mortality rate of any mental illness.

6. FACTS • It is estimated that 8 million Americans have an eating disorder – seven million women and one million men • One in 200 American women suffers from anorexia • Two to three in 100 American women suffers from bulimia • Nearly half of all Americans personally know someone with an eating disorder (Note: One in five Americans suffers from mental illnesses.)

7. Bulimia Nervosa • Binge eating and inappropriate compensatory methods to prevent weight gain • Excessively influenced by body shape and weight • Must occur, on average, at least twice a week for 3 months • Typically within normal weight! • Between binges, individuals usually restrict the number of calories consumed.

8. Binge and Purge • Binge: eating in a discrete period of time an amount of food that is larger than most individuals would eat under similar circumstances • Purge: engagement in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

9. Bulimia Features • Typically ashamed of their eating problems and attempt to conceal their symptoms • Binge eating usually occurs in secrecy • Binge eating typically continues until the individual is uncomfortably, or even painfully, full. • Binge eating us typically triggered by dysphoric mood, interpersonal stressors, intense hunger after dietary restraint, feelings related to body weight, shape and food. • Disparaging self-criticism and depressed mood often follow.

10. Essential feature • Recurrent use of inappropriate compensatory behaviors to prevent weight gain. • Most commonly vomiting, which is employed by 80-90% of individuals with bulimia. • Can also include misuse of laxatives and diuretics. • Some will also misuse enemas following episodes of binge eating. • Excessive exercise is another compensatory behavior often used by those with bulimia.

11. Bulimia Associated Features • Increased frequency of depressive symptoms • Increased frequency of anxiety symptoms • Depression and anxiety frequently diminish following effective treatment • Lifetime prevalence of substance abuse is at least 30% among those with Bulimia. • Many have personality features that meet criteria for personality disorders, most frequently Borderline Personality Disorder.

12. Physiology • Fluid and electrolyte abnormalities • Loss of stomach acid through vomiting • Significant and permanent loss of dental enamel, chipped teeth, increased frequency in cavities • Enlarged salivary glands • Calluses or scars on the hands • Loss of cardiac and skeletal muscle tissue • Menstrual irregularities or amenorrhea • Esophageal tears, gastric rupture, and cardiac arrhythmias, and rectal prolapse

13. Culture, Age, Gender, and Prevalence • Similar frequencies in most industrialized countries: U.S., Canada, Europe, Australia, Japan, New Zealand, and South Africa. • Individual with the disorder are primarily white. • 90% are female. • Lifetime prevalence for women is 1%-3% • Prevalence for men is one tenth of that. • Usually begins in late adolescence or early adulthood. • Periods of remission longer than a year are associated with better long-term outcomes.

14. Refusal to maintain a minimally normal body weight Intense fear of gaining weight Significant disturbance in the perception of shape or size of his/her body Amenorrhea: the absence of a menstrual period in a woman of reproductive age. Weigh less than 85% of weigh that is considered normal for age and height Anorexia Nervosa

15. Anorexia Nervosa Weight loss is usually accomplished by reduction in total food intake Most eventually end up with a very restricted diet that is sometimes limited to only a few foods Intense fear of becoming fat not alleviated by weight loss Concern about weight gain often increases as weight decreases

16. Diagnostic Features • Self esteem is highly dependent on body shape and weight • Weight loss is seen as an impressive achievement and a sign of extraordinary self-discipline • Weight gain is perceived as an unacceptable failure of self-control • May acknowledge being thin, but typically deny serious medical implications.

17. Anorexia Subtypes • Restricting Type • Eats very little and loses weight primarily through dieting, fasting, or excessive exercise. Calories consumed are insufficient to support bodily functions and activities. • Binge-Eating/Purging Type • Regularly engage in binge eating or purging • Self induced vomiting or misuse of laxatives, diuretics, or enemas. • Some do not binge eat, but do regularly purge after eating small amounts of food. • Has symptoms of anorexia and bulimia. About 50% of people with anorexia also develop bulimia

18. Associated Features and Disorders • Manifest depressive symptoms: depressed mood, social withdrawal, irritability, insomnia, diminished interest in sex. • Depressive symptoms may be a result of semistarvation. • Obsessive-compulsive features are often prominent; when related to food, may be due to undernutrition.

19. Physiology • Can affect most major organ systems and produce a variety of disturbances. • Anemia, dehydration, problems with liver function, low estrogen levels, arrhythmias, electrolyte disturbances • Constipation, abdominal pain, cold intolerance, lethargy, excess energy, hypotension, hypothermia, dryness of skin, lanugo, bradycardia, edema, yellowing of the skin, hypertrophy of salivary glands, cardiovascular problems, dental problems, and osteoporosis.

20. Prevalence • Anorexia is far more prevalent in industrialized societies. • U.S., Canada, Europe, Australia, Japan, New Zealand, and South Africa. • Rarely begins before puberty • Lifetime prevalence is 0.5% among females. • Prevalence has increased in recent decades.

21. Course • Usually begins between 14-18 • Rarely occurs in women over 40 • Onset may be associated with a stressful life event • Hospitalization may be required to restore weight and to address fluid and electrolyte imbalances • Mortality from anorexia is over 10%! • Death most commonly results from starvation, suicide, or electrolyte imbalance.

22. Other features of anorexia: • Concerns about eating in public, feelings of ineffectiveness, a strong need to control one’s environment, inflexible thinking, limited social spontaneity, perfectionism, and overly restrained initiative and emotional expression. • A substantial portion have a personality disturbance that meets the criteria for a personality disorder, often Borderline Personality Disorder.

23. WHY?! • Nurturing • Addiction • Trauma • Survival Strategies • Reenactment • Suppression • Disordered eating is an attempt to control, hide, stuff, avoid and forget emotional pain, stress and/or self-hate • Short-term relief for long-term destruction • Multi-factorial in origin: While family dynamics are certainly important, so too are biological predisposition to anxiety and mood disorders, interpersonal effectiveness skills, and cultural expectations of beauty.

24. How we can understand • "Why are you doing this to yourself?""You have good things in your life, what's the problem?" • Not a conscious choice where a person suffering from an Eating Disorder would prefer that lifestyle as opposed to one filled with self-love and happiness • Coping mechanism • a means for dealing with depression, stress and self-hate that has been built up over many years • It is a reflection of how the person suffering feels about themselves inside • Mothers, fathers, siblings, supportive friends have little influence in creating the true self-esteem required for permanent recovery, to cope with life positively, and to learn to believe that we deserve good things in life and happiness. • These disorders are about the person suffering and how they feel about themselves.

25. Family • Families where children are not permitted to express emotions and are prohibited from expression of the natural frustrations and anger related to daily injustice, rage begins to develop. • Because the natural responses are suppressed, strong emotions must seek • release in indirect ways. Strong emotion can be suppressed and satisfied by eating behavior. "I am frustrated and overwhelmed."="I am hungry." "I am out of control."=“Control food intake." "I am lonely and afraid."="I am hungry."

26. Mental health and dads • Research findings indicate the relationship between fathers and daughters has a significant impact on the long term mental health of girls. • Positive reinforcement and lack of body image criticism is particularly important during a girl’s adolescent years

27. Families: Part of the problem or solution • Positive or negative image reinforcement • Positive or negative behavior modeling • Supportive or critical when a problem is evidenced • Open or secretive • Guiding versus controlling

28. Are families at fault? "With a change in our understanding of the distress found within families of AN, our view of these families can be transformed from being part of the problem to being part of the solution."

29. What can we do? • Discourage dieting, as it rarely works in the long term. • Model healthy eating without restriction, self-criticism, or overeating. • Avoid focusing too much on appearance or weight, as perceived pressure to be thin can lead to disordered eating. • Encourage children to develop strengths such as music, art, or sports to foster healthy self-esteem. • Focus on mastery of an activity rather than comparing themselves to others. • Refer promptly for diagnosis and treatment when you suspect mood disorders or eating problems.

30. VIDEO: Killing ME Softly • http://www.youtube.com/watch?feature=player_embedded&v=jWKXit_3rpQ

31. Resources • Life Without Ed, Jenny Schaefer • Wasted, MaryaHornbacher • Somethingfishy.org • http://ap.psychiatryonline.org/article.aspx?articleID=50181 • http://www.vanderbilt.edu/AnS/psychology/health_psychology/famstruc.htm • http://www.youtube.com/watch?v=U-N2Cv52gB8 • http://www.youtube.com/watch?v=loszrEZvS_k

32. Questions? • Jill Ahrens, M.Ed., LPC • Beth Fowler, Ph.D. • Rev. Adam Greene